8 Little Sinuses Are One Major Headache

The weather warms a bit, hinting that the end of winter is near. Buds form on the tree limbs where newly returned birds are perched. Grass and flowers begin poking up through the soil, announcing that soon the emerald Orange County spring will be upon us, spreading pain and misery in its wake.

Granted, this is the biased viewpoint of the sinus sufferer, but there seem to be so many of them. "You can go to any office in Orange County, toss a paper clip and probably hit someone who complains of sinus problems," said Dr. Victor Strelzow, director of the UC Irvine medical school's airway disorders section and a nose and sinus specialist.

But according to Strelzow, who has treated thousands of such sufferers with medicines and with surgery, the main cause of sinus complaints in Orange County is not spring's pollen or humidity or smog or head colds or line-drives to the cheek. It's television.

"People blame a lot of nasal complaints--postnasal drip, runny nose, stuffiness, headaches--on sinus problems because of television advertising," he said. In reality, a small minority of those complaining actually have anything wrong with their sinuses, he said.

It's probably about one in 10, according to Dr. Victor Passy, a UCI professor of head and neck surgery or otolaryngology. (If "otolaryngology" seems a mouthful, it used to be "otorhinolaryngology.")

"Anyone who thinks his headache is a sinus headache is probably wrong," said Dr. Harold S. Novey, a UCI immunologist specializing in allergies. "Tension headaches are much more common, in my opinion." He estimated that 7% of the population suffers from allergic sinus problems.

To those who do suffer, however, the symptoms of sinusitis can be a general feeling of malaise or a nagging, recurring ache or a sudden onset of severe pain. An amazing number of people simply live with the pain, unaware of what is actually causing it and what can be done to allay and prevent it, Strelzow said. The sinuses are merely air-filled cavities in the skull, eight altogether: one in each cheek, two between the eyes, two behind those, and two in the forehead above the nose.

Each is lined with the same kind of membrane that lines the nose, and each is connected to the nasal passage by a small hole in the skull called an ostium. The hole is a bit smaller than the opening in the smallest drinking straw.

Do these sinuses serve any good purpose? There are differing opinions among physicians. Novey said the best opinions are only educated guesses ranging from warming inhaled air or insulating the base of the skull to improving voice resonance or merely making the skull lighter. Strelzow, however, believes the sinuses' purpose is to provide room for additional nasal membrane. These membranes are needed to produce the fluids that prevent the nasal and throat passages from drying out.

"When you get a cold and have to breathe through your mouth, your mouth and throat can get very dry and sore," Strelzow said. "So when you breathe through your nose, why doesn't your nose get dry and sore?"

The reason, he said, is that clear mucous is produced in the nasal membranes and is carried back through the nasal passage by the motion of microscopic hairs called silia. Strelzow said an adult produces between 1 and 1 1/2 liters of this mucous each day, much of it in the sinuses, to counteract the drying effect of inhaling air. The mucous also protects by trapping inhaled bacteria and microscopic particles.

Generally speaking, only one thing goes wrong: The sinus openings swell shut for some reason or become obstructed, and that prevents the mucous from draining. The mucous is still produced, however, creating a pocket of warm fluid that is heaven for bacteria. That can lead to inflammation and infection, and for most sinus sufferers, that means pain.

Allergic reactions can cause the blockage by turning a person's own antibodies against him or her, according to Novey.

Antibodies are proteins produced in the body that attack and neutralize threatening intruders such as bacteria and viruses. Allergic people, however, are genetically disposed to produce antibodies against harmless substances such as plant pollen. These well-meaning but overzealous antibodies can be produced within the nasal membranes, where they wait to sound the false alarm.

The pollen becomes lodged in the nose and sinuses, drawn in with the 10,000 quarts of air inhaled by a person in one day. The pollen breaks down, its component parts soak through the nasal membrane, and there they meet the antibodies. There can be 60,000 antibodies waiting on one membrane cell. If two or more adjacent antibodies react simultaneously, they set off a reaction in that cell, and in Rambo fashion, the cell shoots first and asks questions later. Ordered to attack, it releases microscopic beads of chemicals intended to wipe out the invading enemy.